Provider Demographics
NPI:1639437320
Name:SACRED HEART HOME HEALTH CARE INC
Entity Type:Organization
Organization Name:SACRED HEART HOME HEALTH CARE INC
Other - Org Name:SACRED HEART HOME HEALTH AND HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEVINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-334-1058
Mailing Address - Street 1:7735 WASHINGTON AVE STE D
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66112-2464
Mailing Address - Country:US
Mailing Address - Phone:913-334-1058
Mailing Address - Fax:913-334-1196
Practice Address - Street 1:7735 WASHINGTON AVE STE D
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-2464
Practice Address - Country:US
Practice Address - Phone:913-334-1058
Practice Address - Fax:913-334-1196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSA105163251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSA105163OtherKANSAS STATE LICENSE